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A type of malingering or factitious disorder in which the patient, usually a vagrant, wander from hospital to hospital, feigning severe illness of dramatic and emergency nature in order to be admitted. The “patient�?, always a confabulating, pathologic lyer, may even practice self-mutilation in order to prove pain. Once admitted to a hospital, they usually create havoc by demanding special attention and quarrelling violently with the doctor and nurses. Their story is clinically plausible - and subsequently invariably found to be false. When detected, such patients leave one hospital and appear in the emergency room of another, and they may sometimes departure from hospital against medical advice.

Patients have a history of many hospital admissions and extensive travelling; police record and borderline drug addiction. Having been discharged he is likely to turn up at another hospital with the same story, or at the original hospital with another story. The expert pretence and degree of subterfuge these patients employ in order to have innumerable diagnostic procedures or additional major operations are almost inconceivable. Such patients submit to uncomfortable diagnosis procedures, such as gastroscopy, and exhibit an utter lack of comprehension of the risks of repetitive surgery. Patients of this type are seldom recognised in time to receive psychiatric diagnoses and therapy, which they need. Male to female ratio 3: 1; age ranging from 19 to 62 years (mean 39). The eponymic designation was suggested by Richard Asher in 1951.

Münchhausen patients may be extremely expensive to the health care system. According to Guinness Book of Records (1993), William McIloy cost Britain’s National Hospital Service about $4 million over 50 years. 400 major and minor operations, 100 different hospitals using 22 aliases.

# R. Asher:

Munchausen's syndrome. Lancet, London, 1951, I: 339-341.

# P. Chapman:

Munchausen’s syndrome. Lancet, London, 1951, 1: 412-413.

# J. S. Chapman:

Perigrinating problem patients: Munchausen’s syndrome.

Journal of the American Medical Association, Chicago, 1957, 165: 927-933.